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href="https://cayapapichullakumani.com/aviso-legal/">Aviso Legal</a></li> <li class="page_item page-item-959"><a href="https://cayapapichullakumani.com/politica-de-cookies/">Política de Cookies</a></li> <li class="page_item page-item-958"><a href="https://cayapapichullakumani.com/politica-de-privacidad/">Política de Privacidad</a></li> <li class="page_item page-item-7"><a href="https://cayapapichullakumani.com/quienes-somos/">La Asociación</a></li> <li class="page_item page-item-13"><a href="https://cayapapichullakumani.com/contexto/">Contexto</a></li> <li class="page_item page-item-21"><a href="https://cayapapichullakumani.com/actividades/">Actividades</a></li> <li class="page_item page-item-27"><a href="https://cayapapichullakumani.com/colaboradores/">Colaboradores</a></li> <li class="page_item page-item-32"><a href="https://cayapapichullakumani.com/imagenes-actividades-medicas/">Imagenes (actividades médicas)</a></li> <li class="page_item page-item-37"><a href="https://cayapapichullakumani.com/captacion-de-fondos/">Captación de fondos</a></li> <li class="page_item page-item-40 current_page_item"><a href="https://cayapapichullakumani.com/hazte-socio/" aria-current="page">Hazte socio</a></li> <li class="page_item page-item-47"><a href="https://cayapapichullakumani.com/ser-voluntario/">Ser voluntario</a></li> </ul></none> </div>  </div>  <div id="content" class="layout-sidebar-no group">  <div id="primary" class="group"> <h2>Hazte socio</h2> <div id="post-40" class="group post-40 page type-page status-publish hentry"><p><img loading="lazy" class="aligncenter" src="https://cayapapichullakumani.com/wp-content/uploads/2013/04/ColaborI.jpg" alt="ColaborI" width="864" height="304" /><div class="two-fourth"><p> La asociación amigos del Cayapas o Cayapa pi chulla kumani, como es su traducción en la lengua local, le invita a colaborar en el desarrollo de las actividades sociosanitarias, aportando 20 euros al año.</p> <ul> <li>La cuota anual estará destinada a:</li> <li>Medicamentos y material sanitario</li> <li>Transporte fluvial</li> <li>Traslado de pacientes a centros de referencia</li> <li>Gestión logística</li> <li>Gastos en gestión de la asociación<br /> </div> <div class="two-fourth last"><p> <iframe loading="lazy" data-cli-class="cli-blocker-script" data-cli-label="Youtube embed" data-cli-script-type="non-necessary" data-cli-block="true" data-cli-element-position="body" data-cli-placeholder="Accept <a class='cli_manage_current_consent'>No necesarias</a> cookies to view the content." data-cli-src="//www.youtube.com/embed/nZa2Kiid4fY" width="415" height="234" frameborder="0" allowfullscreen="allowfullscreen"></iframe> </p> </div></li> </ul> <p> </p> <div role="form" class="wpcf7" id="wpcf7-f675-p40-o1" lang="es-ES" dir="ltr"> <div class="screen-reader-response"></div> <form action="/hazte-socio/#wpcf7-f675-p40-o1" method="post" class="wpcf7-form" novalidate="novalidate"> <div style="display: none;"> <input type="hidden" name="_wpcf7" value="675" /> <input type="hidden" name="_wpcf7_version" value="5.1.7" /> <input type="hidden" name="_wpcf7_locale" value="es_ES" /> <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f675-p40-o1" /> <input type="hidden" name="_wpcf7_container_post" value="40" /> <input type="hidden" name="g-recaptcha-response" value="" /> </div> <table style="text-align: left; width: 794px; height: 64px;" border="1" cellpadding="0" cellspacing="1"> <tbody> <tr> <td style="vertical-align: top;">Al rellenar el presente formulario y remitirlo a la Asociación “Cayapa Pi Chulla Kumani - Amigos del Cayapas”, manifiesto mi intención de hacerme socio de la misma y doy mi consentimiento para que se efectúen en mi banco, hasta nueva orden, los cargos especificados a continuación con la periodicidad descrita.<br> </td> </tr> <tr> <td style="vertical-align: top; text-align: center;"><span style="font-weight: bold;">La cuota mínima para ser socio es de 20€ anuales</span><br> Los campos marcados con asterisco (*) son obligatorios.<br> </td> </tr> <tr> <td style="vertical-align: top; background-color: rgb(224, 224, 224);"><span style="font-weight: bold;">Su aportación (*):</span> Quiero hacerme socio/a con una cuota de:<br> </td> </tr> <tr> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap Importe"><span class="wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox" id="importe"><span class="wpcf7-list-item first"><input type="checkbox" name="Importe" value="20€" /><span class="wpcf7-list-item-label">20€</span></span><span class="wpcf7-list-item last"><input type="checkbox" name="Importe" value="Otra cantidad €" /><span class="wpcf7-list-item-label">Otra cantidad €</span></span></span></span> <span class="wpcf7-form-control-wrap importe2"><input type="number" name="importe2" value="" class="wpcf7-form-control wpcf7-number wpcf7-validates-as-number" id="importe2" aria-invalid="false" /></span><br> </td> </tr> <tr> <td style="vertical-align: top; background-color: rgb(224, 224, 224);"><span style="font-weight: bold;">La periodicidad de mi cuota será (*):</span><br> </td> </tr> <tr> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap periocidad"><span class="wpcf7-form-control wpcf7-radio" id="periocidad"><span class="wpcf7-list-item first"><label><input type="radio" name="periocidad" value="Semestral" /><span class="wpcf7-list-item-label">Semestral</span></label></span><span class="wpcf7-list-item last"><label><input type="radio" name="periocidad" value="Anual" /><span class="wpcf7-list-item-label">Anual</span></label></span></span></span></td> </tr> <tr style="font-weight: bold;"> <td style="vertical-align: top; background-color: rgb(224, 224, 224);">Datos personales (*): <span style="font-weight: normal;"><span class="wpcf7-form-control-wrap tiposocio"><span class="wpcf7-form-control wpcf7-radio" id="tiposocio"><span class="wpcf7-list-item first"><label><input type="radio" name="tiposocio" value="Particular" /><span class="wpcf7-list-item-label">Particular</span></label></span><span class="wpcf7-list-item last"><label><input type="radio" name="tiposocio" value="Entidad" /><span class="wpcf7-list-item-label">Entidad</span></label></span></span></span></span></td> </tr> <tr> <td style="vertical-align: top; text-align: center;"> <table style="text-align: left; width: 785px; height: 110px;" border="0" cellpadding="0" cellspacing="0"> <tbody> <tr> <td style="vertical-align: top; width: 197px;">Nombre y Apellidos (*)<br> </td> <td style="vertical-align: top; width: 582px;"> <span class="wpcf7-form-control-wrap nombre"><input type="text" name="nombre" value="" size="64" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" id="nombre" aria-required="true" aria-invalid="false" /></span></td> </tr> <tr> <td style="vertical-align: top; width: 197px;">NIF/CIF</td> <td style="vertical-align: top; width: 582px;"><span class="wpcf7-form-control-wrap nif"><input type="text" name="nif" value="" size="64" class="wpcf7-form-control wpcf7-text" id="nif" aria-invalid="false" /></span></td> </tr> <tr> <td style="vertical-align: top; width: 197px;">Dirección<br> </td> <td style="vertical-align: top; width: 582px;"><span class="wpcf7-form-control-wrap direccion"><input type="text" name="direccion" value="" size="64" class="wpcf7-form-control wpcf7-text" id="direccion" aria-invalid="false" /></span><br> </td> </tr> <tr> <td style="vertical-align: top; width: 197px;">Población<br> </td> <td style="vertical-align: top; width: 582px;"><span class="wpcf7-form-control-wrap poblacion"><input type="text" name="poblacion" value="" size="64" class="wpcf7-form-control wpcf7-text" id="poblacion" aria-invalid="false" /></span><br> </td> </tr> <tr> <td style="vertical-align: top; width: 197px;">Codigo Postal y Provincia<br> </td> <td style="vertical-align: top; width: 582px;"><span class="wpcf7-form-control-wrap cp"><input type="text" name="cp" value="" size="8" class="wpcf7-form-control wpcf7-text" id="cp" aria-invalid="false" /></span><span class="wpcf7-form-control-wrap provincia"><input type="text" name="provincia" value="" size="54" class="wpcf7-form-control wpcf7-text" id="provincia" aria-invalid="false" /></span><br> </td> </tr> <tr> <td style="vertical-align: top; width: 197px;">Teléfono (*) </td> <td style="vertical-align: top; width: 582px;"><span class="wpcf7-form-control-wrap telefon"><input type="tel" name="telefon" value="" size="64" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" id="telefon" aria-required="true" aria-invalid="false" /></span></td> </tr> <tr> <td style="vertical-align: top;">E-mail (*) </td> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap email"><input type="email" name="email" value="" size="64" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" id="email" aria-required="true" aria-invalid="false" /></span> </td> </tr> <tr> <td style="vertical-align: top;">Fecha de nacimiento </td> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap nacimiento"><input type="date" name="nacimiento" value="" class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" id="nacimiento" aria-invalid="false" /></span> </td> </tr> </tbody> </table> </td> </tr> <tr> <td style="vertical-align: top; background-color: rgb(224, 224, 224);"><span style="font-weight: bold;">Forma de pago</span> (obligatorio elegir una de las dos opciones) </td> </tr> <tr> <td style="vertical-align: top;"> La forma de pago será mediante domiciliación bancaria, para lo que requerimos los siguientes datos: </td> </tr> <tr> <td style="vertical-align: top;"> <table style="text-align: left; width: 785px; height: 42px;" border="0" cellpadding="0" cellspacing="0"> <tbody> <tr> <td style="vertical-align: top; width: 170px;">Titular cuenta (*)</td> <td style="vertical-align: top; width: 583px;"><span class="wpcf7-form-control-wrap titularcuenta"><input type="text" name="titularcuenta" value="" size="64" class="wpcf7-form-control wpcf7-text" id="titularcuenta" aria-invalid="false" /></span></td> </tr> <tr> <td style="vertical-align: top; width: 170px;">Nombre banco o caja (*)</td> <td style="vertical-align: top; width: 583px;"><span class="wpcf7-form-control-wrap nombrebanco"><input type="text" name="nombrebanco" value="" size="64" class="wpcf7-form-control wpcf7-text" id="nombrebanco" aria-invalid="false" /></span></td> </tr> <tr> <td style="vertical-align: top; width: 170px;">Código cuenta cliente</td> <td style="vertical-align: top; width: 583px;"><span class="wpcf7-form-control-wrap idbanco"><input type="text" name="idbanco" value="" size="6" maxlength="4" class="wpcf7-form-control wpcf7-text" id="idbanco" aria-invalid="false" /></span> - <span class="wpcf7-form-control-wrap idoficina"><input type="text" name="idoficina" value="" size="6" maxlength="4" class="wpcf7-form-control wpcf7-text" id="idoficina" aria-invalid="false" /></span> - <span class="wpcf7-form-control-wrap iddc"><input type="text" name="iddc" value="" size="2" maxlength="2" class="wpcf7-form-control wpcf7-text" id="iddc" aria-invalid="false" /></span> - <span class="wpcf7-form-control-wrap idcc"><input type="text" name="idcc" value="" size="20" maxlength="10" class="wpcf7-form-control wpcf7-text" id="idcc" aria-invalid="false" /></span> IBAN: <span class="wpcf7-form-control-wrap iban"><input type="text" name="iban" value="" size="10" maxlength="10" class="wpcf7-form-control wpcf7-text" id="iban" aria-invalid="false" /></span><br> </td> </tr> </tbody> </table> </td> </tr> <tr> <td style="vertical-align: top; background-color: rgb(224, 224, 224);"><br> </td> </tr> <tr> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap informacion"><span class="wpcf7-form-control wpcf7-checkbox" id="informacion"><span class="wpcf7-list-item first last"><input type="checkbox" name="informacion[]" value="No quiero recibir comunicaciones de “Asociación amigos del Cayapas” en mi dirección de correo (electrónico o postal) facilitada en el presente formulario." /><span class="wpcf7-list-item-label">No quiero recibir comunicaciones de “Asociación amigos del Cayapas” en mi dirección de correo (electrónico o postal) facilitada en el presente formulario.</span></span></span></span> </td> </tr> <tr> <td style="vertical-align: top;"><span class="wpcf7-form-control-wrap condiciones"><span class="wpcf7-form-control wpcf7-acceptance"><span class="wpcf7-list-item"><input type="checkbox" name="condiciones" value="1" aria-invalid="false" id="condiciones" /></span></span></span>* He leído y acepto las <a class="thickbox" href="https://cayapapichullakumani.com/dialogs/soci/?TB_iframe=1&width=600&height=400" title="Condiciones" onclick="return false">Condiciones de privacidad</a> </td> </tr> <tr> <td style="vertical-align: top; text-align: right;"><input 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